Public Opinion and Public Policy: Heroin and Other Opioids
| Date | 01 October 2019 |
| Published date | 01 October 2019 |
| Author | Henry H. Brownstein,Amy Kyle Cook |
| DOI | 10.1177/0887403417740186 |
| Subject Matter | Articles |
research-article2017
Article
Criminal Justice Policy Review
2019, Vol. 30(8) 1163 –1185
Public Opinion and
© The Author(s) 2017
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DOI: 10.1177/0887403417740186
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and Other Opioids
Amy Kyle Cook1 and Henry H. Brownstein*
Abstract
Virginia, much like other states, has experienced unprecedented rates of heroin and
prescription opioid abuse, overdoses, and deaths. Given the wide range of competing
voices concerning drug policy and the complicated situation of the contemporary
opioid epidemic, this study examines whether public opinion is reflected in public
policy toward illicit involvement with opioids. The 2016 Commonwealth Public Policy
Survey, a statewide representative sample of 1,000 Virginia residents, found that
Virginians are supportive of treatment over arrest for heroin and prescription pill
abusers and factors such as race, education, and political affiliation are predictive of
support for treatment over arrest. More importantly, the results of this poll converge
with legislative policies of the 2017 General Assembly, supporting the notion that
public support can have an influence on the policymaking process. Policy implications
are discussed.
Keywords
criminal justice policy, drug offenders, public opinion, heroin, opioids
Public policy has been defined as “what public officials within government, and by
extension the citizens they represent, choose to do or not to do about public problems”
(Kraft & Furlong, 2015, p. 3). Making public policy entails making decisions about
whether or not something is a problem for a community of people, the relative severity
of that problem, and the appropriate way or ways to respond to the problem, and then
taking action to formulate a strategy to address the problem, to gain support for the
strategy, to design a plan, and to implement and evaluate the plan (cf. Anderson, 2011;
1Virginia Commonwealth University, Richmond, VA, USA
*Henry H. Brownstein retired from Virginia Commonwealth University in June 2017.
Corresponding Author:
Amy Kyle Cook, Virginia Commonwealth University, 923 W. Franklin Street, Richmond, VA 23284, USA.
Email: cookak@vcu.edu.
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Criminal Justice Policy Review 30(8)
Birkland, 2011). This process takes place in a “marketplace of claims” (Best, 1990),
wherein individuals and organizations compete and collaborate to argue in favor of or
against particular decisions or actions related to their own vested interest or favored
values (H. H. Brownstein, 2007). Arguably, in a democratic society, public policy
should favor or at least reflect the interests and claims of its citizens (Shapiro, 2011),
which for practical purposes are observable as public opinion and measurable as find-
ings from public opinion surveys (Burstein, 1998; Page & Shapiro, 1983). In this
article, we present findings of a study of public opinion in relation to public policy
with regard to a contemporary concern about which people across the United States
have differing opinions: how to address the expanding use, abuse, and misuse of her-
oin and other opioids in their communities.
Public Opinion and Public Policy
Research and scholarly analyses in recent decades suggest that in democratic societies
there is (Beckett, 1994; Burstein, 2003; Monroe, 1998; Warwick, 2015; Zimring &
Johnson, 2006) and should be (Burstein, 1998; Lafont, 2014) a robust relationship
between public opinion and public policy. In a review of studies using publications in
major journals as a source of data, Burstein (2003) determined,
It turns out that public opinion influences policy most of the time, often strongly.
Responsiveness appears to increase with salience, and public opinion matters even in the
face of activities by interest organizations, political parties, and political and economic
elites. (p. 29)
There has been more than a century of social and political undercurrents, contradic-
tions, and conflicts in public policy with regard to illicit drugs in the United States (H.
H. Brownstein, 2013; Caulkins & Reuter, 2006; Kleiman, 1992; MacCoun & Reuter,
2001). These underlying disagreements are manifested today in terms of the public
concern for heroin and other opioids as a problem. Consequently, contemporary drug
policy is a particularly good case through which to study the relationship between pub-
lic opinion and public policy (cf. Beckett, 1994; Blendon & Young, 1998; H. H.
Brownstein, 2013; McBride & Terry-McElrath, 2016). The convergence today of a
broad reassessment of drug policy in general and the particular situation of heroin (an
illegal drug sold through illicit markets to users who are highly stigmatized) and other
opioids (many of which are legally manufactured and sold through doctors who pre-
scribe them for medical purposes to users who may or may not have a legitimate need)
spreading across both geographical and social boundaries presents a unique opportunity
to study the relationship between public policy and public opinion in a democracy in
the context of a potentially very competitive and impassioned marketplace of claims.
Drug Policy and Opioids in the United States
Different drugs at different times under different circumstances have been and con-
tinue to be widely used to treat people who are ill or feeling poorly (Chou, Ballantyne,
Cook and Brownstein
1165
Fanciullo, Fine, & Miaskowski, 2009; Kalso & Vainio, 1990; Mather, 1995; Reisman,
2011; World Health Organization, 2007). At other times, under different circum-
stances, different drugs have been and continue to be used by some people to relieve
stress related to trauma or even stress related to everyday life, or by some people who
just want to experience enhanced personal well-being or pleasure (Goode, 2012;
Huxley, 1954; O’Malley & Valverde, 2004; Weil, 1972). However, using a particular
drug in a way that it was not intended to be used, or misusing or abusing any drug, can
have a negative impact on personal health and also on personal relationships and social
experience (Health and Human Services, 2016; National Center for Health Statistics,
2016). The point is that different drugs in different circumstances used by different
people in different ways can sometimes be harmful, and can sometimes be beneficial.
Drugs are normal in society and will always be with us, but having them around in a
way such that their benefits outweigh their harm requires careful consideration about
how, when, and why what drugs should or should not be used by whom and how they
should or should not be used and dispensed.
The Context of Drug Policy in the United States
Throughout the 20th century, there was limited knowledge and much uncertainty
about the benefits and harms of particular drugs. Faced with insufficient knowledge
and uncertainty and confronted by myriad competing claims about drugs and the peo-
ple involved with them, being cautious, public policymakers and citizens in most
nations around the world favored drug policies prohibiting the production, distribu-
tion, and use of a number of specified drugs among some or all people in some or all
circumstances (Bewley-Taylor, 2003; Musto, 1991, 1999). There were and continue to
be ongoing debates about the relationship between drugs and drug using and public
health and safety, and about the relative levels of benefit and risk of having various
drugs available to all or some people (see H. H. Brownstein, 2013; Caulkins, Hawken,
Kilmer, & Kleiman, 2011; DuPont & Voth, 1995; Erickson & Hathaway, 2010;
Herring, Thom, Beccaria, Kolind, & Moskalewicz, 2010; Inciardi & Harrison, 2000;
McBride & Terry-McElrath, 2016; Musto, 1991; Riley et al., 1999). Nonetheless, over
the century as drug policy was made, enacted, and enforced it continuously evolved in
the face of new and expanding knowledge, changing social conditions and cultural
values. Today, the transformation of drug policy is especially pronounced showing
signs of shifting from its historical heavy emphasis on public safety to a greater con-
cern for public health (H. H. Brownstein, 2016; Rosmarin & Eastwood, 2012; Taylor,
Buchanan, & Ayres, 2016), and the contemporary opioid epidemic is relevant to
understanding this transformation.
Opiates and Opioids
In the middle of the 19th century, opium products were available without restriction
and were widely used for a variety of medical purposes (M. J. Brownstein, 1993). As
it became clear that people using these drugs were becoming addicted to them,
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scientists began conducting research to synthesize new nonaddictive opium alkaloids
(Sneader, 1998). In 1898, a period of unregulated drug use and distribution, Bayer, a
German pharmaceutical company, introduced a new opium alkaloid it called heroin
and reported its value as a cough suppressant and a treatment for people with serious
lung disease (Sneader, 1998). Unfortunately, these new alkaloids proved to be as
addictive as the opium products they were intended to supplant and policies were
introduced first to control and eventually to outlaw their use.
The opium products used during the 19th century, including morphine, are natural
products extracted from opium plants and are called opiates; heroin and other synthe-
sized products derived from opium are chemical...
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